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General NPI Number Information
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NPI Number | 1891358867
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Entity Type | Organization
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Legal Business Name | CHRISTINA L. GREEN, PMHNP-BC, PLLC
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 05/24/2020
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Provider Practice Location Address
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Address Line | 3101 JOE RAMSEY BLVD E STE 104
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City | GREENVILLE
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State | TX
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Zip | 75401-7762
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Country | US
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Telephone | 903-454-1700
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Fax | 903-454-1701
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Provider Business Mailing Address
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Address Line | 4702 WESLEY ST STE C
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City | GREENVILLE
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State | TX
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Zip | 75401-5663
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Country | US
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Telephone | 903-454-1700
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Fax | 903-454-1701
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA L GREEN
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Credential | APRN, PMHNP
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Telephone | 903-454-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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